eMJA: The verdict from ALLHAT

To the Editor: The publication of the main results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), and the accompanying editorial, triumph the role of thiazide diuretics as first-line management for hypertension.1,2 It brought to mind the lines from the nursery rhyme Old Mother Hubbard — "And when she went there, the cupboard was bare."

Simple frequency analysis of diuretic antihypertensive medications listed in the Australian Medicines Handbook (1998 and 2003) revealed that the total number of thiazide diuretics available as monotherapy in 1998 was six (bendrofluazide chlorothiazide, chlorthalidone, hydrochlorothiazide, methyclothiazide and indapamide), and in 2003 three (bendrofluazide, chlorthalidone and indapamide).3,4

Appel L. The verdict from ALLHAT — thiazide diuretics are the preferred initial therapy for hypertension. JAMA 2002; 288: 3039-3042. <PubMed>
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981-2997. <PubMed>
Australian Medicines Handbook, 1st edition. Adelaide: Australian Medicines Handbook Pty Ltd, 1998.
Australian Medicines Handbook, 4th edition. Adelaide: Australian Medicines Handbook Pty Ltd, 2003.

(Received 30 Jan 2003, accepted 3 Feb 2003)

Correspondence: Dr Mark R Nelson, Department of Epidemiology and Preventive Medicine, Monash University, Commercial Road, Prahran, NSW 3181 mark.nelsonATmed.monash.edu.au

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